Subcapsular renal hematoma after ureterorenoscopy

Abstract

Introduction Subcapsular renal hematoma after ureterorenoscopy using a holmium yttrium‐aluminum‐garnet laser is a rare complication. We experienced a case of subcapsular hematoma after ureterorenoscopy. Case presentation The patient was a 56‐year‐old man with a history of hypertension and coronary vasospastic angina, and he was taking antiplatelet drugs. He had the middle and lower calyx stones measured 36 mm in diameter of the right kidney. We performed ureterorenoscopy, which was completed about 2 h without intraoperative complications. We could not remove the stone completely. After the surgery, the patient developed a fever and complained of right back pain. Computed tomography showed several residual stones formed a stone street, obstructing the stent and resulting in grade 3 hydronephrosis. Furthermore, the right subcapsular renal hematoma infection had detected. Percutaneous hematoma drainage and percutaneous nephrostomy were performed. Conclusion Subcapsular renal hematoma after ureterorenoscopy is an uncommon complication but should be kept in mind.

Uncommon Complications of Cystoscopy: Presentations of Concurrent Perirenal Hematoma and Candida albicans Sepsis

“…Risk factors for developing PRH include hydronephrosis, thin renal cortices, prolonged operative duration, preoperative urinary tract infections, larger stone size, ureteral stent usage, ureteral sheath usage, higher perfusion pressures, and prior renal operation/shock wave lithotripsy [ 1 ]. On the contrary, factors such as patient age, body mass index, diabetes mellitus, history of urolithiasis, hypertension, presence of multiple stones, and stone location have had questionable or statistically insignificant associations with the development of both PRH and SRH [ 3 ]. The patient not only presented with a prior history of ureteral stent placement but also had a history of hypertension, diabetes mellitus, bilateral hydronephrosis, nephrolithiasis, and laser lithotripsy, making him a prime candidate for developing PRH after ureteroscopy and cystoscopy.…”

Editorial Comment from Dr Kanno to subcapsular renal hematoma after ureterorenoscopy

“…reported a case of subcapsular hematoma after ureteroscopic surgery for renal stones. 3 This is a very important report, and the clinical course appears to be instructive. Subcapsular hematoma after extracorporeal shock wave lithotripsy for renal calculi is well known, but there are limited reports of subcapsular hematoma after ureteroscopy.…”

“…Here, Harada et al. reported a case of subcapsular hematoma after ureteroscopic surgery for renal stones 3 . This is a very important report, and the clinical course appears to be instructive.…”

Editorial Comment from Dr Anan to subcapsular renal hematoma after ureterorenoscopy

“…reported a case of subcapsular hematoma after URS. 3 They treated the middle and lower calyx stones, measuring 36 mm in diameter, of the right kidney in 2 h by URS. However, the stones could not be entirely removed.…”